Chase was named one of the most influential people in Digital Health due to his entrepreneurial success & writing along with luminaries such as Eric Topol, Patrick Soon-Shiong, Vinod Khosla & Elizabeth Holmes. He speaks to & consults with new ventures inside of established companies & high growth startups. Chase is widely published. The book Chase co-authored won the healthcare Book of the Year in in 2014.
Chase has a penchant for making connections between previously disconnected trends and making them understandable and actionable. Chase is in the development stage of a documentary that seeks to make the indecipherable understandable and demonstrate that there is reason for great optimism that a partnership between doc-entrepreneurs and forward-looking clinicians with individuals (fka “patients”) can dramatically out-perform against Quadruple Aim* objectives compared to traditional healthcare orgs.
*The Quadruple Aim is the Triple Aim (improved outcomes & patient experience with lower costs) plus the overlooked 4th Aim — clinician satisfaction critical to improving the current condition where an alarming number of clinicians are overburdened & burnt-out which negatively impacts their lives as well as the individuals they care for.
Chase was the CEO & Co-founder of Avado, which was acquired by and integrated into WebMD and the most widely used healthcare professional site - Medscape.
Before Avado, Chase spent several years outside of healthcare in startups as founder or consulting roles with LiveRez.com, MarketLeader, & WhatCounts. He also played founding & leadership roles in launching two new $1B+ businesses within Microsoft.
Chase is a father, husband & oxygen-fueled mt sport athlete. His 2014 team placed 3rd in their division & 24th overall (out of 500 teams) in America's oldest adventure race (7 legs -- XC ski, downhill ski, run, road bike, canoe, mt. bike & sea kayak) where Dave took on the Nordic ski leg. Dave was a former PAC-10 800 Meter competitor.

Direct Primary Care: Key Issues and the Future

This article is a section of a longer paper on Direct Primary Care (DPC) that was introduced in an earlier piece – Health Plan Rorschach Test: Direct Primary Care. The following excerpt from that article briefly explains DPC if it’s a new concept. Click through the previous link for additional context.

Despite its inclusion in Obamacare, Direct Primary Care (DPC, aka Concierge Medicine for the Masses), it’s surprising how few health insurance executives know about DPC. DPC is a model of paying for primary care outside of insurance. The individual or organization paying for healthcare pays a monthly fee (like a gym membership) for all primary care needs. Generally, DPC providers say they can address 80 or more of the top 100 most common diagnoses.

[Contact me via LinkedIn if you'd like a copy of the full seminal study on the Direct Primary Care model - excerpts will be published on Forbes]

Key Issues and the Future

The growth and evolution of DPC will be dynamic. In this section, detailed are some of the open issues and questions that might impact the evolution of the DPC market. Finally, how things to evolve in the future are outlined.

Does DPC exacerbate the primary care physician shortage?

The most common critique of DPC is that if you substantially reduce panel sizes, this markedly exacerbates the primary care shortage in this country unless there is at least a 2-4x increase in the number of PCPs being trained. It is estimated that there will be a shortage of 35,000-44,000 primary care physicians by 2025[i]. This is a particularly significant issue with the aging population since DPC providers are restricted in how they can serve the Medicare population. There is legislation[ii] proposed by Rep. Bill Cassidy, MD (R-LA) and Jay Inslee (D-WA) to expand DPC to cover Medicare patients. One must look at the causes of the shortage of PCPs and analyze whether DPC addresses or worsens the issue.

Dr. Josh Umbehr is a DPC practitioner takes this issue head-on:

The increased accessibility and quality of DPC can’t help but mitigate the shortage. I am the urgent care. I am the ER. I do the home care needed to decrease hospitalizations. I’m their pharmacy and the lab. I’m their diagnostic center. I’m the missing link to ensure continuity of care and eliminate costs. How many fewer doctors are needed now because one doctor is correctly incentivized to improve all of these factors? How many physicians will avoid retirement, change their practice, and return to and embrace Family Medicine again? How many students will gravitate towards primary care now because it’s better care, better lifestyle and better money?

The following are the primary factors for the PCP shortage:

The top issue according to a Physicians’ Foundation study that stated half of PCPs would leave medicine if they could was the red tape associated with insurance. Respondents stated they are spending more time on paperwork than patient care.

Primary care is one of the lowest compensated specialties in medicine. Roughly 40% of medical school students enter in a primary care related field such as Internal Medicine. However, by the time they graduate from medical school, only about 10% haven’t sub-specialized due in large part to school loans they’ll have to repay. The American Medical Association’s Relative Value Scale Update Committee (“RUC” for short) largely determines how medicine is compensated. It has long been dominated by specialists. Thus, it’s not surprising that specialists related activities receive the highest value.

The practice model of a typical PCP is described by many as a “hamster wheel” as productivity goals result in patient encounters averaging less than 10 minutes. This is unsatisfying to most PCPs who recognize that a longer encounter is necessary to deliver optimal care.

MedLion’s Dr. Samir Qamar describes what led him to start MedLion in response to the issues he saw with traditional insurance-based primary care.

“While I was in my residency, I was struck by how dissatisfied the PCPs I was training with were. They were running so fast they weren’t able to deliver the kind of care the family doctors I grew up with provided. It was clear that they were simply a loss-leader for high margin referrals for other medical services. What else can happen if you have 7 minutes per patient? There isn’t enough time to look beyond a presenting symptom and order a test, prescribe a drug or refer out as quickly as possible.

I also observed all of the time doctors spent dealing with billing issues and the accompanying administrative staff. In a practice such as MedLion’s, we run on a very, very low overhead model. This allows us to charge a very reasonable amount that is affordable to farm workers and many uninsured patients we care for. We feel DPC is making primary care attractive again. Not only will more med students choose this path but we are finding doctors who left primary care are coming back when they learn about the DPC model.”

As DPC proponents would say, the way to solve the primary care shortage is to make it appealing once again. DPC directly addresses the issues that have led to the shortage in the first place. Dr. Umbehr drew an interesting analogy.

I’m sure you know how the argument goes, if you don’t want an animal to go extinct, eat it. To monetize buffalo meat is to ensure that, like chickens and cows, the buffalo will never go extinct. Well, I’m here to tell you that PCPs are Noooooo different. Reward their work and make their work rewarding and you’ll have a shortage of specialist before you know it!

The following items remain open questions or issues that need to be tracked in the months and years ahead:

Is Direct Primary Care a limited phenomenon, or are there signs that it will grow to (pick some relevant metric)?

Will DPC become a part of state health insurance exchanges, and will employers and consumers choose to go the DPC/catastrophic coverage route?

Regional employee benefit consulting firms and brokers such as Lockton and The Holmes Organisation have embraced DPC. Will national players such as Towers, AonAon and others embrace DPC with their clientele?

Will practices that have adopted the Patient-centered Medical Home take the next move to DPC and remove insurance from a portion of their practice?

Future

In the foreseeable future, healthcare will remain dynamic and somewhat unpredictable, particularly the political dimensions. However, one can reasonably expect the following to be drivers of the evolution of DPC and primary care, in general.

Massive competition and innovation: It’s hard to imagine a more competitive time period than we are entering today. The winners in the fee-for-service game have been those who have been most adept at maximizing billing codes as that is what the incentive system has rewarded. As the reward system in healthcare shifts to value and outcomes, primary care is the clear winner. Unlike the past, a premium will be placed on those organizations most able to deliver high quality primary care. One can expect a tremendous amount of innovation as a result.

Care will be provided closer and closer to home. As has been seen in places such as Denmark where primary care has been prioritized due to its efficacy, more than 80% of patient-physician interaction is no longer face-to-face. When it is necessary, DPC models either bring the provider to the patient’s home/workplace or one can get in almost immediately to the doctor’s office rather than waiting days or weeks. The payment mechanisms of DPC allow remote care to be offered without as much concern about financial incentives/disincentives.

The income disparity between specialists and primary care physicians will narrow. The combination of the increased value being placed on proactive primary care coupled with a limited supply of primary care physicians suggests that they will earn more money in the near to medium term feature.

Fee-for-service will wane. If an organization can’t demonstrate positive outcomes and measure them, they will be pushed out.

Broadly speaking, healthcare is going to be subject to deflationary pressures as private and public sector budgets are unable to support the current level of spending, let alone further healthcare inflation. Lower overhead models demonstrate that lower cost doesn’t have to mean lower profits or lower positive health outcomes.

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Direct care is the only solution to primary care, IMO at least. I just wish the model would deploy where I live! As William Gibson so said so trenchantly in ’03, “the future is hear, it’s just not evenly distributed.”